Provider Demographics
NPI:1265430292
Name:KANE, JESSE A (MD)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:A
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100294
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0294
Mailing Address - Country:US
Mailing Address - Phone:352-273-7584
Mailing Address - Fax:352-392-3498
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2230
Practice Address - Country:US
Practice Address - Phone:352-273-7584
Practice Address - Fax:352-392-3498
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059536207V00000X
FLME36705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104837400Medicaid
GADH1281OtherRAILROAD MEDICARE - GROUP #
GA234608607BMedicaid
421005OtherWELLCARE OF GA
GA059536OtherPHYSICIAN LICENSE
GA11D0941435OtherCLIA ID -2010 OCILLA RD
GA234608607AMedicaid
GA11D1105865OtherCLIA ID - 17 JOHNSON ST
GAP00787893OtherRAILROAD MEDICARE - PTAN
GAP00787893OtherRAILROAD MEDICARE - PTAN
421005OtherWELLCARE OF GA
GADH1281OtherRAILROAD MEDICARE - GROUP #